plasma cell dyscrasias

Question 1

what is a monoclonal gammopathy?

Answer 1

• result of clonal plasma cell or lymphoproliferative disorder
• single antibody produced resulting in homogenous M protein

Question 2

name the 4 major monoclonal gammopathies

Answer 2

1) monoclonal gammopathy of uncertain significance
2) multiple myeloma
3) waldenstrom macroglobulinemia
4) amyloidosis

Question 3

what is SPEP?

Answer 3

• serum protein electrophoresis

- best way to detect an M protein (paraprotein)

Question 4

what is UPE?

Answer 4

• urine protein electrophoresis

- to detect light free light chains (bence-jones) in urine

Question 5

multiple myeloma is a neoplasm of the….

Answer 5

plasma cell

Question 6

what is a myeloma cell?

Answer 6

post-germinal center plasma cell that has undergone class switching

Question 7

what do plasma cells express?

Answer 7

CD38 and CD138

Question 8

what is the growth factor for MM cells?

Answer 8

IL-6

Question 9

7 potential presentation features of MM

Answer 9

1) bone pain from increased osteoclastic activity due to IL-6
2) hypercalcemia
3) normochromic normocytic anemia
4) recurrent infections due to deficiency in antibodies
5) renal insufficiency - light chain deposits
6) hyperviscosity syndrome
7) plasmacytomas - solid tumors of plasma cells

Question 10

MM diagnosis SPEP/UPEP

Answer 10

• 60% IgG
• 20% IgA
• k:l ratio different than 2:1

Question 11

MM diagnosis - skeletal survey

Answer 11

• x-ray for lytic lesions

Question 12

MM diagnosis - CBC

Answer 12

anemia

Question 13

MM diagnosis - bone marrow

Answer 13

plasma cells greater than 10% (normal < 5%)

Question 14

Mayo Clinic diagnostic criteria for MM

Answer 14

1) M protein in serum or urine
2) 10% or more clonal plasma cells in marrow
3) end organ impairment (CRAB)

hyperCalcemia
Renal insufficiency
Anemia
lytic Bone lesions